CPT 99155

Mod Sed Other Phys/Qhp Initial 15 Mins <5 Yrs

CPT 99155 pays $81.50 in a non-facility setting and $81.50 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $75.53 in Wisconsin to $110.28 in Alaska, a 46% spread.

National non-facility rate

$81.50

Office and other outpatient settings

Facility rate
$81.50

Hospital and ASC settings

Highest state
$110.28

Alaska

Lowest state
$75.53

Wisconsin · 46% spread

Medicare rate by state

53 Medicare jurisdictions, highest to lowest. State values average every locality in the jurisdiction at a 33.4009 conversion factor.

Non-facilityFacilityNational $81.50
CPT 99155 Medicare reimbursement rate by state, 33.4009 conversion factor, 2026 Physician Fee Schedule. National non-facility $81.50, national facility $81.50.
StateRate compared visuallyNon-facilityFacility
Alaska
$110.28$110.28
Florida
$89.12$89.12
Illinois
$88.68$88.68
New York
$88.55$88.55
District of Columbia
$87.61$87.61
New Jersey
$86.69$86.69
Connecticut
$85.22$85.22
Michigan
$84.15$84.15
West Virginia
$83.64$83.64
Maryland
$83.37$83.37
Massachusetts
$83.29$83.29
Washington
$83.21$83.21
Georgia
$82.71$82.71
Pennsylvania
$82.42$82.42
New Mexico
$82.28$82.28
Rhode Island
$82.17$82.17
California
$81.94$81.94
Puerto Rico
$81.49$81.49
Virgin Islands
$81.49$81.49
Montana
$81.48$81.48
Colorado
$81.15$81.15
Texas
$81.12$81.12
Louisiana
$81.00$81.00
New Hampshire
$80.91$80.91
Delaware
$80.89$80.89
Ohio
$80.69$80.69
Missouri
$80.55$80.55
Oregon
$80.33$80.33
Nevada
$80.17$80.17
Utah
$80.08$80.08
Arizona
$80.03$80.03
Kentucky
$79.70$79.70
South Carolina
$79.53$79.53
Hawaii
$79.50$79.50
Wyoming
$79.41$79.41
Virginia
$78.97$78.97
Oklahoma
$78.64$78.64
Maine
$78.06$78.06
Mississippi
$78.01$78.01
North Carolina
$77.93$77.93
Vermont
$77.44$77.44
Tennessee
$76.87$76.87
Alabama
$76.77$76.77
North Dakota
$76.74$76.74
Indiana
$76.65$76.65
Kansas
$76.56$76.56
Idaho
$76.47$76.47
Arkansas
$76.20$76.20
South Dakota
$76.18$76.18
Minnesota
$76.15$76.15
Iowa
$75.81$75.81
Nebraska
$75.74$75.74
Wisconsin
$75.53$75.53

Billed by 1 specialties

Commercial rates for 99155

Medicare is the floor, not the market. See what UHC, Aetna, Cigna and BCBS actually pay — down to the TIN.

See negotiated rates